Pituitary Disorders Flashcards

1
Q

Are are the clinical presentation of pituitary tumours

A

Visual loss, headache

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2
Q

What is prolactinoma

A

Where there is a prolactin secreting pituitary tumour

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3
Q

How is a prolactinoma treatmented

A

With dopamine as this decreases the size of the tumour

Radiotherapy or surgery of the pituitary gland affects its other functions

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4
Q

How big is a macro-adenoma

A

Over 1cm

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5
Q

What do prolactin inhibit

A

LH through GnRH

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6
Q

What are the symptoms of hyperprolactinaemia

A

Menstural disturbance
Fertility problems
Galactorrhoea - milky discharge from nipple
Vision loss due to the tumour

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7
Q

How does a tumour cause high prolactin below 5,000

A

It blocks dopamine release and TRH which both inhibit prolactin

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8
Q

What is likely to be the cause if prolactin is above 5,000

A

Active prolactin secretion (prolactinoma)

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9
Q

What are the different treatments for prolactinoma sand pituitary tumours

A

Prolactinomas need dopamine whereas pituitary tumours require surgery

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10
Q

what type of vision loss is accompanied by a pituitary tumour compressing the optic chiasm

A

bitemporal hemi-anopia

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11
Q

what symptoms are associated with a pituitary tumour growing sideways

A

pain and double vision as it compresses eye movement and pain nerves

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12
Q

if there is a tumour blocking movement of hormones from hypothalamus to anterior pituitary gland what will happen to the hormones produced by the anterior pituitary

A

they will decrease except prolactin which will increase as theres no negative control (hypopituitarism)

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13
Q

what does growth hormone deficiency result in

A
children = short statue 
adult = muscle weakness and tiredness
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14
Q

what is the result of a gonadotropin deficiency

A
children = delayed puberty 
adult = loss of secondary sexual characteristics
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15
Q

what are symptoms of a TSH deficiency

A

cold, weight gain, tiredness, slow pulse

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16
Q

what are the symptoms of an ACTH deficiency

A

tired, dizzy, low BP, low sodium

this is life threatening

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17
Q

adenomas of the pituitary gland most commonly produce which hormones

A

prolactin
GH
ACTH

18
Q

which pituitary hormones can a basal blood test screen

A

TSH, LH, FSH, prolactin

19
Q

which pituitary hormones require a dynamic blood test

A

cortisol and GH (these change throughout the day)

20
Q

what types of dynamic blood tests can be taken

A

stimulation test for suspected deficiency and suppression tests for suspected excess

21
Q

what stimulation and deficiency tests are used for ACTH and GH

A

ACTH
stimulation = response to hypoglycaemia
suppression = steroids

GH
stimulation = hypoglycaemic stress
suppression = glucose

22
Q

how can the pituitary gland be viewed

23
Q

what is the treatment for prolactinoma

A

dopamine agonists to stimulate D2 receptors

24
Q

what is the treatment for a non-functioning pituitary adenoma

A

surgery or radiotherapy

25
what drugs can cause high prolactin levels
dopamine antagonists e.g. anti-sickness and anti-psychotic drugs
26
what is acromegaly
where there is a GH secreting pituitary tumour
27
what are the long term complications of acromegaly
- premature cardiovascular death - hypertension - diabetes - increased risk of thyroid cancer - large hands and feet
28
what biochemical tests can confirm acromegaly
oral glucose tolerance test with failure to suppress GH | elevated IGF
29
how is acromegaly treated
- surgical removal of tumor - dopamine agonists and somatostatins to decrease GH secretion - radiotherapy
30
what is Cushing's disease
where there is an ACTH secreting pituitary tumour
31
what is the appearance of Cushing's disease
- round pink face - skinny and weak arms and legs - easily bruised - red stretch marks on abdomen - high blood pressure - diabetes - osteoporosis
32
what is the difference between Cushing's disease and Cushing's syndrome
cushing's syndrome is high ACTH levels not due to a pituitary tumour
33
what is diabetes insipidus
conditions characterised by excesisve thirst and large quantities of pale urine due to a posterior pituitary gland secreting ADH
34
what is another name for ADH
vasopressin
35
what is the role of vasopressin
bind to a vasopressin receptor in the kidney opening aquaporins so that water is reabsorbed
36
what is the difference between cranial and nephrogenic diabetes insipidus
``` cranial = vasopressin deficiency nephrogenic = kidneys giving a lack of response to vasopressin ```
37
what are the consequences of diabetes insipidus
- severe dehydration - high sodium levels (hypernatraemia) - coma - death
38
what is a pituitary apoplexy
a sudden vascular event in a pituitary tumour, this could be: - bleeding in the tumour (haemorrhage) - blood supply cut off (infarction)
39
what is the presentation of pituitary apoplexy
sudden onset headache double vision vision loss hypopituitarism
40
in hypopituitarism which hormone deficiency is the most dangerous
ACTH/cortisol